F096 – Open reduction: Femur
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Open reduction of the femur, a surgical procedure listed in the Musculoskeletal System section of the Schedule of Benefits. This procedure is eligible for surgeon (A suffix), assistant (B suffix), and anaesthetist (C suffix) services. F096 includes intramedullary nail with proximal and distal locking screws if performed. The fee for the anaesthetist is calculated using 8 base units plus time units. The fee for a surgical assistant is calculated using 6 base units plus time units. Refer to the Surgical Assistants' Services (-) and Anaesthesiologists' Services (-) sections of the General Preamble for detailed calculation rules.
When to Use
- Use F096 for the open reduction of a femoral shaft fracture requiring internal fixation, as it specifically includes the insertion of an intramedullary nail with proximal and distal locking screws.
- Select F096 when the surgical approach requires an open incision to achieve anatomical reduction of the femur, distinguishing it from closed reduction procedures like F095.
Common Pitfalls
- Do not bill F096 in addition to F095 or F097 for the same fracture site, as these are considered mutually exclusive components of the same surgical episode.
- Avoid billing for separate hardware removal or additional fixation components as separate procedures, as the Schedule of Benefits considers these inclusive to the F096 fee.
Billing Tips
- Ensure the operative report explicitly details the open reduction technique to justify the use of F096 over closed reduction codes, as this is a common point of audit for musculoskeletal claims.
- When claiming for major trauma (E420A), ensure the Injury Severity Score (ISS) is clearly documented in the patient's record at the time of the procedure to prevent automatic rejection.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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